Date: 15 September 1952
Cert: 19449
Place of Death: County: Knott
City or Town: Bearsville, Ky.
Length of stay (in this place): (blank)
Street address or location: Home at Bearsville, Ky.
Usual Residence of Deceased: State: Ky.
County: Knott
City or Town: Bearsville, Ky. Street Address:
(blank)
Full Name: Carlos Ray PATRICK
Date of Death: 15 September 1952
Sex, Color or Race, Marital Status: Male, White, Never Married
Date of Birth: 29 January 1952
Age: 07 months, 14 days
Usual Occupation: None
Kind of Industry or business: None
Birthplace: Knott, Ky.
Father's Name: Bill PATRICK
Mother's Maiden Name: Emaline RITCHIE
Was deceased ever in armed forces: (blank)
Social Security No.: (blank)
Informant: Bill PATRICK
Disease/condition directly leading to death: Diarrhea &
Vomiting
Interval between onset and death: 04 days
Due to: (blank)
Other significant conditions: (blank)
Date of Operation: (blank)
Major findings of operation: (blank)
Autopsy: No
Accident, suicide, or homicide: (blank)
Place of injury: (blank)
City or Town, County, State: (blank)
Time of Injury: (blank)
Injury occurred at work: (blank)
How did injury occur: (blank)
I hereby certify that I attended deceased from 10 September
1952 to
15 September 1952, that I last saw the deceased alive on 14
September 1952, and
that death occurred at 1:30 a.m., from the causes and on the
date stated above.
Date signed: 16 September 1952
Address: Blue Diamond, Ky.
Signature: L. H. Wagers, M.D.
Burial, Cremation or Removal: Burial
Date: 16 September 1952
Name of Cemetery or Crematory: Patrick Cemetery
Location: Bearsville, Ky.
Date received by local registrar: 18 September 1952
Registrar's Signature: Rose B. Craft
Funeral director & address: John Everage, Hindman,
Ky.
Transcribed by Debbie Tamborski, 26 January 2011 |